Health

Summary

Ms C complained on behalf of her daughter (Ms A) about the treatment Ms A received at the Western General Hospital. She said that the reporting of a scan was unreasonable, and that the arrangements for follow-up appointments after this scan and an operation carried out some nine months later were unreasonable. Finally Ms C was unhappy with the board's handling of her representations.

During our investigation, we took independent advice from a consultant neurosurgeon and a consultant neuroradiologist, after which we upheld Ms C's complaints. In responding to the complaints, the board had accepted that the written report prepared after the scan failed show that there was a significant abnormality and they had apologised for this error. They had suggested improvements as a result, and our adviser said that these should be implemented.

We also found there was a delay in Ms A receiving a follow-up appointment after the scan, for which the board had also apologised. The advice we received was that Ms A's clinical pathway had not changed as a result of this, but it did lead to a considerable delay in telling her about her new diagnosis. The adviser also said that there was no delay in the follow-up appointment after Ms A's operation but we were concerned that she was not provided with the findings reported at the time of her operation during her in-patient stay in hospital. We were satisfied that there was no delay in arranging a further scan after her operation.

The board had apologised that Ms A had not received details of the oncology (cancer) team including the clinical nurse specialist in a timely manner. As a result of these communication problems the board had taken action to improve coordination of neurology patients and their care by establishing a new multi-disciplinary team. Finally, they had accepted failings in their handling of Ms C's complaints and had taken action as a result.

Recommendations

We recommended that the board:

• report back to us on the action taken to implement the improvements proposed; and
• ensure the staff involved in this case are made aware of the importance of ensuring findings reported at the time of the operation are appropriately reported to patients and/or their relatives.

Summary

Miss C complained that the care and treatment she received for her hand after a cycling injury were unreasonable. She raised a number of issues, including that the consultant orthopaedic surgeon, who she saw nearly four weeks after her injury, failed to operate and refer her to physiotherapy at that time. Miss C also complained that the physiotherapy she received after the board did decide to operate, two and a half months after her injury, was unreasonable. She said the physiotherapist only checked her progress and explained what exercises she should do.

We obtained independent advice on this case from two of our medical advisers, a consultant trauma and orthopaedic surgeon (adviser 1) and a consultant physiotherapist (adviser 2). Adviser 1 explained there were different ways to treat hand fractures and that professional opinions on how best to do this could vary. He said that the extent of Miss C's injury was such that, on balance, surgery should have been considered when she initially presented with her injury. Because of this, we upheld the complaint and were critical of the board. However, adviser 1 said that by the time Miss C saw the consultant, the advantages of early surgery had been lost and it was then not unreasonable to see if conservative treatment was successful. Although early surgery would have shortened the time from injury to recovery for Miss C, it was unlikely to have affected the final result. Adviser 1 also explained that a referral to physiotherapy nearly four weeks after injury would not have achieved anything, and had no adverse impact in Miss C's case. Adviser 2 noted that when Miss C did receive physiotherapy treatment, she had good assessment, a comprehensive exercise programme, sensible advice on self-management between treatments and regular reviews on progress.

Recommendations

We recommended that the board:

• feed back our decision on this complaint to the staff involved; and
• provide Miss C with a written apology for the failings identified.

Summary

Mr C, who is an advocate, complained to us on behalf of his client (Ms A) that the board had failed to provide her daughter (Miss B) with appropriate clinical treatment when she was admitted to the Royal Infirmary of Edinburgh with chest pain and other symptoms. We took independent advice on this complaint from one of our medical advisers. Although the board had been unable to provide an explanation for Miss B's symptoms, we found that they had appropriately assessed her chest pain and that she had been appropriately investigated. The medical records also indicated that there had been a reasonable and appropriate attempt to provide her with pain relief. No abnormal cardiac rhythms were found when tests were carried out and there was no evidence that a treadmill test that she had was not carried out or recorded properly. Staff also appropriately involved the relevant specialists in relation to Miss B's earache and hearing problems. We found that the care and treatment provided was reasonable in view of the symptoms that she presented with and we did not uphold the complaint.

Mr C also complained that staff had failed to provide Miss B with an adequate level of occupational and physiotherapy treatment. We found, however, that the assessment and ongoing physiotherapy treatment provided was reasonable and in line with her care plan. We did not uphold this aspect of the complaint.

Finally, Mr C complained that staff failed to communicate adequately with Ms A about her daughter's condition and treatment. We did not uphold this complaint, as we found that they had communicated adequately with Ms A.

Summary

After losing a lot of weight, Mr C was referred for plastic surgery to remove excess skin around his abdomen (abdominoplasty). He had a psychological assessment and was told he would have one procedure. After the surgery at St John's Hospital he reported discomfort and problems and felt that the surgery had created other problems with the appearance of his skin. He had additional 'revision' surgery to correct some of the problems caused by the initial operation. However, he complained the surgery was not successful and he was still suffering from side effects. He was unhappy that the board were no longer willing to offer him further plastic surgery.

We took independent advice from our plastic surgery adviser, who said that Mr C's surgery appeared to have been successful. The second operation had been carried out to tidy up elements of the initial surgery, and would be considered part of the same procedure. He pointed out that before an abdominoplasty it was often difficult to be sure whether one procedure would be sufficient. He also said, however, that if the board had a reason for turning down Mr C's request for further surgery, they should have explained this clearly to him.

We found that while there did not appear to be any problems with the surgery itself, Mr C was not being offered further treatment and had not had a full explanation of why this was. We upheld his complaint and made a recommendation.

Recommendations

We recommended that the board:

• review the potential need for further surgery and ensure this is fully discussed with Mr C. Following this, if Mr C requests an independent second opinion the board should make the appropriate arrangements for this.

Summary

Mrs C's mother (Mrs A) had a distended abdomen and her GP arranged tests for her. Mrs A made an appointment, as requested, to discuss the test results with the GP, and Mrs C said that at the consultation her mother was shocked to be told that she had ovarian and bowel cancer and was given details of the sort of treatment that was available. Mrs C complained to us that the medical practice should have warned her mother she was to be given bad news, so she could take a family member with her.

We took independent medical advice from an adviser who is a GP, who said that it was not for reception staff to interpret test results. We also considered Mrs A's GP's explanation to be reasonable, in that he said Mrs A knew what the tests were for and that it would have been for her to decide if she wanted to bring someone with her to her consultation. We did not uphold this part of the complaint.

Mrs C also complained about the consultation itself. Subsequently, it turned out that her mother did not have cancer, and Mrs C said the GP had jumped to the conclusion that her mother had bowel and ovarian cancer, based on inadequate information.

We considered the GP had been thorough in trying to establish whether Mrs A had cancer. However, our adviser considered that, strictly speaking, the GP could be considered to have acted prematurely in arranging blood tests and in arranging a scan at the same time as the blood tests, as clinical guidance suggested a different approach. We also found the GP had used a test which was not indicated in the diagnosis of bowel cancer. There was no evidence that he had told Mrs A she had cancer, other than indicating that some of the test results raised the possibility of ovarian cancer and should be investigated further. On balance, we considered that the GP had acted reasonably and we did not uphold this part of the complaint. However, we did recommend that the GP review the relevant NHS guidance as a learning opportunity, to help guide his approach in any future cases.

Finally, Mrs C complained about a later meeting she and her mother had with the GP. We concluded that that meeting had been conducted reasonably and also did not uphold that part of the complaint.

Recommendations

We recommended that the practice:

• ensure the GP reflects on relevant guidelines as a learning opportunity.

Summary

Ms C complained that a GP inappropriately gave her father (Mr A) a cortisone steroid injection without taking account of his existing medication and health condition, and without advising Mr A about possible side effects. Ms C was also unhappy with how the GP dealt with her complaint.

We looked at Mr A's medical records and took independent advice from one of our medical advisers. We found that there was no record that the GP had discussed side effects with Mr A, although the GP said they did this. Although we made no formal recommendations, we asked the GP to reflect on their record-keeping. There was no indication from Mr A's existing medication and health condition that he could not be given the injection. We also found that the GP was aware of Mr A's history and, therefore, put themselves in the position of being able to make a reasoned decision that the injection was appropriate. In addition, we found that the GP's response to Ms C's complaint was reasonable in the circumstances. We did not uphold Ms C's complaints.

Summary

Mrs C complained on behalf of her client (Mrs A) about the board's handling of assessments of Mrs A's child in relation to diagnosing autism spectrum disorder (ASD).

Mrs A first reported concerns about her child when they were about two years old, as she felt they had some developmental issues. When the child was between four and five years old, community paediatrics undertook two formal assessments for ASD, both of which concluded that the child did not have ASD (although showed some ASD traits). Mrs A was dissatisfied with these results and sought the opinion of a private psychologist, who also considered her child had some ASD traits, although did not fulfil all the diagnostic criteria for ASD. Over the next nine years, the child continued to have developmental problems and was in on-going contact with health professionals and social workers. The child was also referred on several occasions to the children's reporter, including for non-attendance at school and for lack of parental care. While Mrs A asked on a number of occasions for a further assessment of ASD, the board considered that this had already been ruled out, and did not agree to offer a second opinion.

When the child was ten, Mrs A's solicitor obtained an independent psychologist's opinion for the children's reporter hearing, which found that there had not been appropriate assessments of ASD to date. Mrs A then asked her GP for a second opinion from a different NHS board, and the GP arranged an admission to a hospital outside the board area. As a result of that admission, the child was diagnosed with ASD. In view of the different diagnosis, the board undertook a significant event review (SER). The board also planned to meet with the hospital team which had diagnosed ASD, to discuss the case, although this had not been done at the time of our investigation.

Mrs C complained about the board's failure to undertake appropriate assessments and their handling of Mrs A's complaint. After taking independent medical advice from an experienced psychiatrist, we upheld Mrs C's complaints. Our adviser said that, although the initial assessment for ASD was reasonable for the time, further assessments should have been done when the child continued to have problems over the next few years. The adviser also said that the board should have given Mrs A a second opinion when she asked for one. However, the adviser said that the SER conducted by the board in response to the complaint was reasonable. In relation to the complaints handling, we found that the board had delayed unreasonably in responding to Mrs A's complaint, as well as failing to keep her updated, or respond to her requests for updates on several occasions.

Recommendations

We recommended that the board:

• arrange a meeting with the other board's team that diagnosed ASD, to discuss the differences in diagnosis in this case (as planned during the SER process);
• issue a written apology to Mrs A for the failings our investigation found;
• bring the failings identified in our investigation to the attention of relevant complaints handling staff; and
• remind complaints handling staff of the need to update complainants regularly where the complaint exceeds 20 working days, and to ensure that the full response is issued without undue delay.

Summary

Miss C complained about aspects of her mental health care. However, she did not sign and return a consent form which we had sent her. We had explained in detail that we needed this in order to obtain information, such as her medical records, from the board and that we could do nothing more with her complaint without it. Following a reminder, we closed the complaint without further action as we had still not received the signed form.

Summary

Ms C, who was a patient of the community mental health team, complained that she had been discharged from the service contrary to advice given to her by phone, which was that her case would remain open so that she could arrange support, as needed, related to her employment. The board said a work development officer told Ms C she would be discharged after a period of five weeks. We were unable to reconcile the two very different accounts of this conversation. We found no supporting evidence that the board had reasonably followed their operational procedures which said that discharges from the service were planned with the patient, with advice on staying well and appropriate contact numbers for support organisations clearly communicated. We also found no evidence that a written copy of the discharge summary had been sent to Ms C's GP as it should have been. We recommended that the board review the discharge process.

We found that two mistakes had been made in the response to Ms C's complaint. Firstly the person named as having spoken to Ms C whilst she was attended her appointment had not done so. The second error was a reference to Ms C's employment being temporary rather than probationary. In view of the communication errors we asked the board to apologise to Ms C.

Recommendations

We recommended that the board:

• ensure that patients, GPs and other agencies are being given clear information at the point of discharge in line with the stated operational policy; and
• apologise for failing to communicate effectively with Ms C in relation to her discharge and and for the inaccuracies identified within the response to her complaint.

Summary

Miss C was concerned about a large lump in her mouth, and arranged an emergency dental appointment, where she was given antibiotics and advised to see her regular dentist. By the time Miss C saw her regular dentist a few days later her face was quite swollen. Miss C was advised by her regular dentist to have root canal treatment (RCT) on the infected tooth, noting that Miss C had started this treatment a year earlier but had cancelled the appointment to complete the treatment and not made another.

The dentist administered an anaesthetic to start the treatment, but this did not take effect, so asked Miss C to return the next day. When Miss C returned, the dentist administered the anaesthetic and started RCT. However, by the next day Miss C's face was extremely swollen and she was in considerable pain. She attended another emergency appointment and was immediately referred to hospital, where the tooth was removed and the abscess drained.

Miss C complained to us about the care and treatment she received. In particular, Miss C was concerned that the dentist did not take an x-ray, or attempt to remove the tooth or drain the abscess in her mouth.

After taking independent dental advice, we upheld Miss C's complaints. We found that the dentist should have attempted to drain the abscess, or referred Miss C on if she was not comfortable attempting this. We also found that the dentist should have taken an x-ray before starting RCT. Finally, we found that the dentist's record-keeping was not of a reasonable standard, as there was no proper description of the diagnosis or treatment plan.

Recommendations

We recommended that the dentist:

• issue a written apology to Miss C, acknowledging the failings our investigation found; and
• reflect on the findings of our investigation, as part of their on-going professional development.